In this specification, the term “medicament” encompasses drugs and any and all other materials dispensed subject to presentation of a prescription.
The traditional means of dispensing medication involves a doctor meeting with a patient and prescribing drugs or medications based on a particular diagnosis. A prescription is then hand written or printed, and generally must be signed. The doctor generally updates the patient's 10 paper file, and the patient takes their prescription to a pharmacy to be filled.
Under this traditional system of dispensing medication, various problems arise. For example, a pharmacy can encounter a problem with a prescription because of the illegibility of the handwriting, which requires a call back to the doctor for clarification. There is also a potential problem where the wrong prescription is filled if the pharmacy does not do the call back to clarify a prescription. Further, potential adverse drug interactions are dependant on the doctor manually researching or knowing the interactions in order to recognize the possible issues and alter a prescription on that basis. Under the current system, there is no notification of patient compliance or drug substitution, nor is there notification of so-called ‘double doctoring’ or ‘multi-pharmacying.’
In recent years, two major advancements have occurred in the field of medicament dispensing. The first is electronic prescription capturing methods, systems and apparatus, which improve the overall accuracy and patient record keeping associated with prescribing drugs. The second is the arrival of automated apparatus, typically configured as kiosks, which automatically dispense medication and are located for convenient patient access (for example, in doctors' offices and medical clinics) and are networked into a central computer system for inventory control and management. In this regard, reference may be made to PCT Application No. PCT/CA2007/001220, published on 17 Jan. 2008 under Publication No. WO 2008/006203 (hereinafter, the “PCT Application”), titled “Method, System and Computer Program For Dispensing Drugs,” which is specifically incorporated by reference herein.
More specifically, the PCT Application describes a system having a server computer, a database of patient information linked to the server computer, a computer input means linked to the server computer operable to generate the script for a drug prescribed to a user, and an automated apparatus for dispensing medicaments (referred to in the PCT Application as a robotic prescription dispensary) operable to recognize a human and/or machine readable description in the script, enabling cross referencing between the description and the patient information to validate dispensing the drug to the user on the basis of the input script. A doctor in a clinic can use the computer input means (for example, a tablet computer) linked to the server to input the appropriate prescription information, or accept certain prescription information from the database as being applicable in the particular case for a particular patient. Further, the doctor's tablet computer may display the patient information, e.g., drug history, insurance coverage, etc., and a printer module can print the script as a paper print-out. The server computer and database enable storing, compiling and retrieval of relevant patient information, for example, the patient's personal information such as name and address, as well as health-relevant information such as diagnostic history and drug history. Access to the database can be provided to both the doctor and the automated apparatus for dispensing medicaments via the server, via a secure connection, or via a link between the system and a clinic's existing clinic management system or patient database.
The PCT Application further describes a method for dispensing drugs including generating a script for a drug prescribed to a user, whereby the script includes data elements in the form of a human readable description of the drug and the user and/or a machine readable description of the drug and the user. The script is input to automated apparatus for dispensing medicaments (identified in the PCT Application as a robotic prescription dispensary) which is operable to do the following: (i) recognize the human and/or machine readable description; (ii) authorize dispensing the drug to the user based on a validation means; and, (iii) dispense the drug to the user. The automated apparatus for dispensing medicaments is linked to the server computer enabling cross-referencing between the machine readable description and the patient information to validate dispensing the drug to the user on the basis of the machine readable description.
The described apparatus also includes a user interface, a teleconferencing or videoconferencing means enabling communication between the user and a human validation agent, and a scanning means for capturing an image of the script so that it, if needed, it can be viewed by a human validation agent, such as a licensed pharmacist communicating in the system and with the apparatus from a remote location to the apparatus, to approve a prescription. The user interface of the dispensary apparatus provides detailed and clear instructions to guide the user.
An authentication means confirms the identity of the patient, for example, by prompting for a personal identification number or by biometric means or by associating certain questions to answers provided by the patient that identify the patient to the apparatus, and cross-referencing this information with the patient information stored on the networked database. Once the patient is recognized, the dispensary apparatus prompts the user for a script and the apparatus processes the user-input script either by the above-mentioned human validation agent or by processing the machine readable description (which may be a bar code). This information can be verified with the server and the database. The apparatus may also interface with the server to adjudicate an insurance claim and determine the amount payable by the patient. The patient either accepts or rejects the transaction. If the transaction is accepted, the apparatus interfaces with the server to transact a payment, for example, by prompting the patient for credit card information. Prescription labels and receipts are printed. The apparatus confirms that the drug is correct and drops it into a dispensing area for retrieval by the user while retaining the script in a lock box, and verifies that the purchased drug product has been retrieved. Further, the apparatus may also print and/or provide to the user educational materials relevant to the particular prescribed drugs it dispenses to the user.
The PCT Application further describes that an automated apparatus for dispensing medicaments may, for example, be located in a doctor's office or clinic, and electronically linked to a computer input means used by a doctor prescribing a drug to a patient, for example, either directly or via a server so that a patient can obtain prescribed drugs without having to attend a pharmacy or drug store.
To date, however, the utility of such known medicament dispensary apparatus has been restricted by the limited variety of medications that may be remotely stored or robotically dispensed by them. Therefore, patients, especially those requiring nonstandard dosing, multiple medications, medications requiring special storage or some form of pre-dispense preparation, are often faced with their medication requirements not being able to be fulfilled at such a known apparatus, thereby requiring a trip to a pharmacy for the balance of the prescription and negating the utility of such a dispensary apparatus.
In such a medicament dispensary, it is desirable that the first script ratio is high; i.e. that as many users as possible who present prescriptions with a view to obtaining medicaments will be able to fill their prescription at the kiosk without requiring a trip to the pharmacy.
The first script coverage ratio really depends on how much variation there is in the population of prescriptions that will be presented at the kiosk and it depends on the range of medicaments available at the kiosk. With regard to range of medicaments, the ratio can be increased by increasing the number of different medicaments that can be dispensed at the kiosk. For example, if there are pills for suppressing headaches and there are pills of a different nature for easing rheumatic pain, then the first script coverage ratio is higher than if there were only either one or the other of the head ache pills and the rheumatic pain pills. Similarly, if there are a variety of medicament delivery mode capabilities such as pill delivery and liquid delivery, then the first script ratio is likely to be higher than if there were just one medicament delivery mode capability. Also if there are a variety of amount dispensing capabilities, such as the capability to dispense any number of pills between 1 and 50, then the first script ratio is likely to be higher than if there were just a single pill dispensing capability fixed at, say, 20 pills.
Clearly, if a kiosk is equipped to dispense every conceivable medicament, has every conceivable delivery mode capability and has every conceivable amount dispensing capability, the first script ratio may approach 100%. However, increasing the kiosk capabilities in this way may yield diminishing returns if the expense and complexity of product and operation are also markedly increased. Additionally, adding these capabilities in such a way as to add significantly to the kiosk volume or footprint may present further expense and logistical problems in the sense of readily obtaining convenient and competitively priced sites for such kiosks.
Medicament packages to be dispensed at the robotically controlled dispensing kiosk may be prepackaged pill boxes, bottles or the like having a range of sizes, shapes, weight, weight distribution and surface condition, all of which may create handling problems for a robotic system. Drug companies frequently change packaging, so control algorithms may become ineffective if a control algorithm is based on the product packaging. A control algorithm that prescribes a handling method based solely on pre-recorded product package information (weight, size, etc) is prone to error. To reduce package handling problems, uniform style and shape of outer-packaging can be applied to medicament products, although this is not preferred as it adds additional handling and expense, may introduce other errors, and results in extra packaging materials. Ideally, the control algorithms and the package handling hardware utilized throughout a package picking process should be as flexible as possible commensurate with other demands of the dispensary kiosk.
In known medicament dispensary kiosks for dispensing bottles or packages of drugs or other medicament packages, the packages are typically stacked in a row column rack of bins. To pick a package from a bin, a pick head is driven in X and Y directions to a desired XY position corresponding to the selected bin. A platform forming part of the pick head is then moved in the Z direction to pick the package from the selected bin.
In a prior implementation of a pick head as described in co-pending Canadian Patent Application Serial No. 2,639,239, filed on Aug. 29, 2008, titled “Automated Modular Apparatus For Dispensing Medicaments,” with a pick head at a desired XY position and a platform adjacent the target bin, the platform is moved to a position underlying a slot formed in a lower wall of the target bin. In the package pick action, after the platform is driven a sufficient distance rearwardly in the Z direction, the platform is raised so that an upwardly extending hook on the platform is brought to a position immediately behind the package to be picked. The package to be picked is then hooked out of the selected bin by driving the platform forwardly out of the rack of bins.
Once the picked package is on the platform, further investigation is made to ensure the package is really the one whose selection is desired. Typically, this might include checking a bar code affixed to the package and/or examining physical characteristics of the package such as its shape or weight. The platform, with the package supported upon it, is then moved to a rest position on the pick head whereupon the pick head is driven to another part of the apparatus as part of the dispensing procedure.
Within a medicament storage kiosk of the type described in the co-pending Canadian patent application 2,639,239, it is desirable to have the pick head and its operation occupy a small space so that as much rack space as possible can be used for the storage of medicaments. In the pick operation described previously, the raising of the platform once it has been driven under a bin means that a layer of space under each row of bins must be reserved. In addition, the 3-part platform movement—platform moves rearwardly, platform moves upwardly, platform moves forwardly—is a relatively complex procedure.
It would be valuable if at least a part of the layers of space under each row of bins which are reserved as the platform lifting space could be used for further storage. It would be valuable also if a simpler procedure could be implemented for picking packages from the bins.
As described in the PCT Application, and in co-pending U.S. Provisional Application Ser. No. 61/170,642, filed on Apr. 19, 2009, titled “Automated Apparatus for Dispensing Medicaments,” which is specifically incorporated by reference herein, a medicament dispensary kiosk may be located in a doctor's office or clinic. The interaction between a patient and the kiosk user interface coupled with access to the various networked functionalities means that a patient can obtain prescribed medicaments without having to attend a pharmacy or drug store. The described medicament dispensary apparatus delivers medicament packages to users. Such packages may take the form of bottles, boxes, shrink wrap foil containers, etc., and therefore can be of a range of shapes and sizes.
For medicament dispensing kiosks, each package of dispensed medicament may need has to be labeled. Medicament package labels are typically of a standard shape and size to enable them to be passed through a printer, and must contain critical patient and medication information in conformance with industry standards and offering little scope for variation in shape, size or materials. Such labels are typically applied by running pressure sensitive adhesive back coated labels on a peal-away carrier through a label printer and transferring the printed label to the medicament container such as a bottle or box. Known label transfer methods have used sponges, vacuum, sponges and vacuum in combination, transfer media, transfer roller and pressure pads. There is a need for reliable accurate placement and adhesion of standard flat labels to dispensed medicament products.
In view of these and other user requirements or preferences in the marketplace, an improved automated apparatus for interactively dispensing a labeled medicament package to a user is desirable.